Category Archives: Cardiac Ischemia

In regards to the cardiac ischemia medical directive, the latest indication is now suspected cardiac ischemia. If you have a pt presenting with all signs and symptoms of cardiac ischemia, have given ASA, established an IV, and have given NTG. If the pt's symptoms improve after administration of NTG should you continue with the directive to the full amount of doses provided the pt still meets the conditions?

Can I attempt the Valsalva on a patient who has chest pain? What if the patient has a clear onset of palpitations, then after onset develops chest pain and or shortness of breath?

Should we consider cocaine induced chest pain as ischemic and be treating with ASA and NTG? Example: 20 year old male patient midsternal chest tightness. Admits to using cocaine and the symptoms occurring after that. I guess my question is, is the cocaine causing ischemia which causes the chest pain?

Hello, How would you like us to proceed with a young pt (say under 30) who complains of chest pain and describes it as ischemic pain, saying all the right things ex; pressure, heaviness etc. But who is vitally stable and doesn’t not appear to be in any distress or severe pain. Would you still like us to treat it as ischemia on the side of caution even though it’s most likely anxiety/stess etc ?

If a patient is given first time Nitro by a PCP IV but then isn’t ever actually prescribed nitro by a doctor does this count as prior hx of nitro use? Could a then PCP non IV give this pt nitro the next time they call?

Would the presence of De Winter T waves be enough to transport the patient to the cath lab. I know its considered a STEMI equivalent but there is no actual ST elevation.

Does a prescription of NTG patch count as previous history of use for NTG spray? Would it be a concern that the medication would be administered through a different route and therefore have a different onset of effect?

Good afternoon, my question is related to current ACS treatment guidelines. I have had several STEMI inter-facility transfers within the last month or so where attending physicians have initiated pain management with Fentanyl. Upon receiving patient handover from these physicians they often request that this treatment modality be continued throughout transfer. Due to the current AMHA research regarding increased mortality in ACS and STEMI patients who are treated with morphine, is there any move to eliminate this contraindication from the fentanyl protocol, or to remove morphine from the ACS treatment guidelines? If a Physician requests this treatment modality (fentanyl) are we able to patch around this contraindication for fentanyl or would this go against the spirit of the protocol patching around contraindications? If the Physician has initiated treatment with Fentanyl and we have exhausted our nitro protocol or it is contraindicated will we suffer repercussions for not initiating morphine treatment even when it was requested that we do not by the sending physician? Would we require a patch to NOT treat this patient with morphine? Why there is a heart rate range for nitro? what will happen if HR is below 60bpm and above 159bpm?

Why there is a heart rate range for nitro? what will happen if HR is below 60bpm and above 159bpm?

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